Category Archives: Nicholas’ story

Article written by Reg Green and published in the first page of the Italian newspaper “Il Corriere della Sera” on August 23, 2018

A few months ago I received an email from complete strangers that has haunted me ever since. It came from an English couple, Dave and Debbie Marteau, whose 21-year old son, Jack, was killed in a road accident in Palermo in 2009 and whose organs were donated to three Italian families. Despite repeated attempts in those eight years they have not been able to find out anything about the recipients.

They don’t know if they are young or old, male or female or what they do for a living. They don’t even know if they are alive. Their pain was clear in every line.

The Marteaus wrote to me because my wife, Maggie, and I who are American, donated the organs of our seven-year old son, Nicholas, to seven very sick Italians, after he was shot in an attempted carjacking on the Salerno-Reggio Calabria autostrada in 1994.

Two foreign families, two identical decisions — but in our case the names of the recipients, their pictures and the stories of their rescue from the very edge of death were flashed around world and tens of millions of people realized, many for the first time, that hearts, kidneys, livers and other body parts that would otherwise be buried could instead bring dying people, many of them very young, back to full health.

Everywhere, from Russia and Venezuela to India and Taiwan, the willingness to donate was stimulated. I know because people in all those places have told me they personally were affected. In Italy alone in the following 10 years organ donation rates tripled, a rate of increase no other country has come close to and thousands of people are alive who would have died.

The difference between the two incidents is that in 1999 a law was passed that forbade healthcare personnel from revealing the identity of people involved in a transplant.

The law does not forbid the two sides from contacting each other — it would be unconstitutional if it did – but it has effectively prevented it.

The goal is laudable: to protect privacy and allow the healing process to continue for both donors and recipients. Everyone wants that. The question now is whether the law is being interpreted too rigidly for any family to find information that would help give it peace of mind.

Among other objections, opponents of change often say that if the transplant fails, the donor family may experience again the pain of losing their own loved ones. Maggie and I have personal experience about that. Two of Nicholas’ recipients have died but we have never felt we were losing him again, only the sadness of losing two other brave people with whom we had a bond.

Even then the loss was eased by their families’ gratitude that their loved one had that second chance. After the transplant, Andrea Mongiardo, the boy who got Nicholas’ heart told everyone he now had a Ferrari inside him now instead of a patch-up old jalopy. Valentina Lijoi, a cousin of his, smiled when she told me that story after Andrea died and I told her I feel sure it will make me smile too till my dying day: a beautiful shared moment and surely therapeutic for both of us.

Every country has to decide what degree of connection is desirable but I am convinced that as a general rule letting the two pairs of families, working with their doctors, make that decision offers by far the best chance of success.

In the United States, the two sides can contact each other if both want to – but only if both want to. The first contact is normally by anonymous letter, sent through the hospital, so that neither side can identify the other. The letters are read by their doctors to make sure there are no problems — that one side, for example, is not likely to make demands that the other does not want.

In time, if all goes well, they can reveal their names. Typically, they exchange stories that warm each other’s hearts. The recipients say what they can do that they were too ill to do before the transplant. The donor families describe what the donors’ favorite sports were, if they had children, tell anecdotes.Their doctors are ready to help resolve any friction that might occur and either party can break off contact at any stage.

Elling Eidbo, CEO of the Association of Organ Procurement Organizations, the US government-appointed organizations that administer these programs, says most donor families interact with their recipients in some way. These organizations, which work closely with hospitals all across the country, confirm that in the large majority of cases the results are positive: they help recovery not hinder it.

Can things go wrong? Of course. That’s life. But those occasions are rare. To give just one example: the CEO of one of the most successful OPOs says that in 38 years in his area, which has millions of people, he can remember only two cases of contact causing problems in his area, which includes millions of people. Two! In 38 years!

As a foreigner, it is not my place to make recommendations but I have a question about how the law is being applied: is preventing the few cases that go wrong worth denying every Italian family who wants it the consolation of knowing more about the people who saved their lives or whose lives they saved?

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After taking me to dinner at the famous Cesarina restaurant in Rome the other night — once the second home of Federico Fellini and Marcello Mastroianni — my host, a renowned transplant surgeon, told the maitre d’ that I was the father of an American boy who was shot in an attempted carjacking on the Salerno-Reggio Calabria autostrada and whose organs were donated to seven Italians, four of them teenagers. “Ah, Nicholas Green,” came the reply and as we shook hands I saw tears in his eyes.

It was deeply satisfying to me for my seven-year old son to be remembered in the company of such gods of world cinema but, I have to say, not a great surprise. Twenty years ago, I wrote ‘an open letter’ to the Italian people, thanking them for their massive eruption of support for our family. In a long lifetime I still can’t recall anything else like it anywhere in the world.

Now, just back from my latest visit, I am writing another open letter to mark an equally unprecedented event: the continuation of that emotion after all these years. I have grown used to it but in many ways it is even more meaningful than the initial upsurge.

Italy has turned its sorrow into the most practical benefit possible. immediately after Nicholas was killed organ donation rates soared and went on soaring for 10 years until they are now triple what they were then, a rate of increase no other country has come close to. Thousands of people are alive, who would have died, including many children. a gain of that size must have contributory causes but no one doubts that the prime reason was the story of one small boy and Italy’s generous-hearted response to it.

History is littered with good causes of white-hot intensity that cool a few months later. Every day the media is full of tragedies, sometimes involving thousands of deaths that a year or two later most readers find difficult to remember in any detail. Yet this one small death has stayed in the hearts of millions of Italians, many of them who were just children themselves when Nicholas was killed.

On this latest visit I heard again what I have heard on the forty something other times I have been in Italy to talk about organ donation: people of all types, from professors of philosophy to members of an alpine rescue team, saying just where they were when they heard we had donated his organs: “I had just come home from work,” “I heard it on the car radio when I was going to pick up my daughter from school.” “My whole family were glued to the television set waiting for more news” and tears come to their eyes. This is the kind of thing we who are old enough to remember used to say after President Kennedy was shot to describe our shocked disbelief.

On a recent trip to Sicily I talked to a class of small children, who listened wide-eyed as I told them how a little boy not much older than them had saved the lives of five people and restored the sight of two others. “You and your wife spoke in this school in the year after Nicholas was killed,” the principal reminded me. It was only then that i realized I was talking to the children of the children who had also gazed at me in wonder that day in 1995.

In the hallway of another school there are two clocks, one like those in every other Italian school, the other marked ‘bodega bay time,’ a daily reminder of the little village in California where Nicholas lived and a continuing stimulus to the idealism of the students.

Traveling on a road in southern Italy last year, we suddenly came to a road block manned by strikers from a local factory. The line of traffic was long and growing. Burly men were on hand to silence anyone pleading to get through. My driver drove on slowly but undaunted. “Get back over there,” the strike leader ordered us. “I’m with the father of the American boy who was shot,” the driver replied. “He’s going to give a speech about organ donation.” A suspicious face peered inside the car, then broke into a smile. “Let this one through,” he told his fellows and off we went.

Nicholas at the age of 7, on the Alps, a few days before he was killed

Every segment of the population continues to show its sympathy: young, old, rich, poor, every shade of political opinion, every religion or none, some of the world’s most prominent men — Maggie and I have met two Italian prime ministers and a president, all of whom have treated us like old family friends, not as leaders of their country — and some of the most beautiful women. At a dinner at the White House for a visiting prime minister, some years ago, where i was a guest, I spoke to Sophia Loren, another guest, who told me, “We Italians feel very close to you.” (Wow!). One night in Rome, when blonde bombshell Alessia Marcuzzi was sitting at a nearby table in a restaurant, I introduced myself as Nicholas’ father. That night she wrote a short piece on her Facebook page. Normally she receives a thousand ‘likes’ for these posts. For this one, it was 39,000 including thousands of passionate comments in favor of organ donation.

The Catholic Church has been heartfelt in its support at every level. Pope John Paul II authorized the making of a magnificent bell with Nicholas’ name and those of his recipients on it for a bell tower commemorating children who have died that we built in Bodega Bay. On the tower are 140 other bells, most of them sent by Italian families. I think of it as a little piece of Italy’s soul on the Pacific Ocean. At the grassroots level, an order of young nuns, The Apostles of the Interior Life, who combine four hours of prayer a day with the most tender compassion for humanity, were eager to help extract the greatest possible good out of Nicholas’ death, when I visited them in Rome recently.

I also met for the first time Valentina Lijou, a cousin of Andrea Mongiardo, the boy who at age 15 received Nicholas’ heart and who died a few weeks ago. Two years older than her, he had been the driving force in their childhood games. “He was always making us laugh,” she said. By the time of the transplant, however, he was receiving transfusions of blood products twice a week, a gaunt, frail little figure who could barely shuffle to the door of his apartment. All that changed with the transplant: “I’ve now got a Ferrari for a heart,” he used to say. Like most transplants, this one didn’t prolong a sickly life: it transformed it and, until last June, he was living a more or less normal life in good spirits and with a job. Once, when I met him, I remember putting my hand on his heart and feeling it beating strongly and regularly. “Good boy, Nicholas,” I said to myself. To the very end that heart did its work perfectly and Andrea’s death was due not to its weakening but to respiratory failure.

I think everyone who has heard about Nicholas knows he loved Italy: Maggie, who studied architecture, gave him his fascination with its art and monuments and I, through my love of history, helped add color. But it was his own personality that brought all this together into an appreciation for Italy far beyond his years. He thrilled to the idea of the ancient roads radiating out from the center of Rome to the ends of the known world, he was astonished by the mosaics at Ravenna and when I read to him the story of the blinded Polyphemus running his hands over the giant rams where Ulysses’ men were clinging I thought he would burst with excitement.

Having lost all this, we are asked at almost every stop, “Don’t you hate Italy?” I hope the answer is clear. Maggie and I have never thought that Italy pulled the trigged. Two criminals killed Nicholas: it could have happened anywhere. But what couldn’t have happened anywhere was the response. I don’t think any other country in the world would have shown involvement of this order. It was that flood of human warmth that helped turn a reckless act of brutality into a universal lesson in which life has triumphed over death and hope over despair.

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The boy who received my son’s heart died Tuesday, although he wasn’t really a boy any longer. He was 37 years old. But when my 7-year old son, Nicholas, was shot in an attempted carjacking on a family vacation in Italy, Andrea Mongiardo was just 15.

At the hospital in Sicily, my wife, Maggie, and I decided to donate Nicholas’ organs and corneas for transplant. They went to seven very sick Italians, four of them teenagers.

Perhaps the most agonizing feature of being on a transplant waiting list is that patients can do nothing at all to influence if and when a new organ becomes available. Their future depends entirely on whether a family they have never met is willing to put its own mourning aside to help total strangers.

When Maggie and I were told that Nicholas had no brain activity, it was she who said, in her usual thoughtful way, “Shouldn’t we donate his organs?” We had no sense of what the outcome would be, who could be saved, what they would be like. But we realized we could squeeze some good from what was otherwise just a meaningless act of violence.

What we couldn’t have guessed was how much good: News of our decision spread like wildfire and so galvanized Italy that in the next 10 years organ donation rates there tripled, an increase no other country came close to. As a result, thousands of people are alive who would have died.

Some of Nicholas’ recipients were very close to death. One was a diabetic who was almost blind, couldn’t walk without help and was dependent on others. After receiving Nicholas’ pancreas cells, she moved into an apartment of her own for the first time in her life.

A 19-year-old got Nicholas’ liver. The day he died, she was in a coma. She bounced back to health, married her childhood sweetheart a year later, and a year after that they had a baby boy, whom they named Nicholas. He is now a tall, handsome young man with no trace of the liver weakness that has dogged his family.

Andrea took longer to heal. He had been sick for so long that his strength was undermined and, whereas the other six were soon back in circulation, he only slowly came back to full health. But when he did, it was for real. He got a job, played soccer, lived more normally than he had ever been able to growing up.

And that is how things stood until we got an email on Tuesday. “His heart was still functioning,” Andrea’s longtime doctor told us, “but the lungs were fibrotic because of drug toxicity related to chemotherapy treatment received three years ago after diagnosis of lymphoma. The final cause of death was respiratory failure.”

It was deflating, like the loss of a young nephew you never dreamed would go before you did. But we don’t feel as if Nicholas died all over again, as some doctors fear will happen to donor families. And, of course, we still have no regrets about the decision we took in 1994.

When the Italian media first asked Maggie how she felt about our son’s heart being transplanted into another boy’s chest, she said: “I always hoped Nicholas would have a long life. Now I hope his heart has a long life.”

Sadly, Nicholas’ heart didn’t reach old age. It did, however, perform nobly for three decades. I’m not surprised: I always knew it was pure gold.

What we couldn’t have guessed was how much good: News of our decision spread like wildfire and so galvanized Italy that in the next 10 years organ donation rates there tripled, an increase no other country came close to. As a result, thousands of people are alive who would have died.

Some of Nicholas’ recipients were very close to death. One was a diabetic who was almost blind, couldn’t walk without help and was dependent on others. After receiving Nicholas’ pancreas cells, she moved into an apartment of her own for the first time in her life.

A 19-year-old got Nicholas’ liver. The day he died, she was in a coma. She bounced back to health, married her childhood sweetheart a year later, and a year after that they had a baby boy, whom they named Nicholas. He is now a tall, handsome young man with no trace of the liver weakness that has dogged his family.

Andrea took longer to heal. He had been sick for so long that his strength was undermined and, whereas the other six were soon back in circulation, he only slowly came back to full health. But when he did, it was for real. He got a job, played soccer, lived more normally than he had ever been able to growing up.

And that is how things stood until we got an email on Tuesday. “His heart was still functioning,” Andrea’s longtime doctor told us, “but the lungs were fibrotic because of drug toxicity related to chemotherapy treatment received three years ago after diagnosis of lymphoma. The final cause of death was respiratory failure.”

It was deflating, like the loss of a young nephew you never dreamed would go before you did. But we don’t feel as if Nicholas died all over again, as some doctors fear will happen to donor families. And, of course, we still have no regrets about the decision we took in 1994.

When the Italian media first asked Maggie how she felt about our son’s heart being transplanted into another boy’s chest, she said: “I always hoped Nicholas would have a long life. Now I hope his heart has a long life.”

Sadly, Nicholas’ heart didn’t reach old age. It did, however, perform nobly for three decades. I’m not surprised: I always knew it was pure gold.

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On organ donation day in Italy (May 29), a cycling team led by Francesco Avanzini, a 62 year-old man who had a kidney transplant 29 years ago, cycled the very tough 50 kilometers, along the glorious coast from Sestri Levante to Genoa. It was like many other activities for organ donation that day but for me it had not one, not two, but three special features. First, I have become friends with Francesco and have seen a degree of moral courage in him that matches the physical courage he needed to stay alive. Second, the race went close to the very first place I stayed in Italy 65 (!) years ago when I had saved enough money to go abroad for the first time. And third could I, as a young man, have ever imagined on that first visit that a race would one day pass this way that would end at a bridge named for my own son?

High in the Swiss Alps, in the little town of Anzere, 34 children from around the world, aged 6 to 17, were preparing to ski down a 45 degree slope in a revered competition that at one time none of them could have dreamed of being in.

It was a perfect day for the climax of the World Winter Transplant Games: the Nicholas Cup.

The weather was calm and clear, the sun dazzling on the pure white snow. The course was treacherous, however, hard ice in places, difficult to dig in the edges of the skis to cut the angles round the gates and more difficult than for the usual run of skiers because, a week earlier, none of these children had ever been on skis. Until then, some – such as those from Tunisia, Hong Kong and Israel – had never seen snow. “I falled over a few times at first,” one small face said proudly. “But I’m alright now.”

Day 1: First hesitant steps.

But the real challenge was of an order of magnitude greater than all that. All of them had once been so ill that their only cure was an organ transplant: a new heart or liver, kidneys or lungs to replace the ones that were dying inside them.

Some had been desperately sick at birth – yellow or blue or a lurid shade of green. One had kidneys the size of peas. A third had to be fed through a tube and, says his mother, “for the first two years he never laughed.” Some could not walk across a room without stopping for breath. Others had lived normal lives, until felled by a virus that at first seemed no more severe than a headache. The first that one father knew of a problem was a scream in the night as one of his daughters heard her younger sister collapse on the floor and then kept her alive for forty minutes as the ambulance crew talked him through the CPR procedure.

For many of these children any form of exercise, let alone a competition mixing risk with athletic agility, was physically impossible. On top of that the years of dependence could have eaten away fatally at their self-confidence. Yet, on the day of the race, one by one the little figures appeared at the starting gate, high on the mountainside. Some came down with what the commentator charitably called “a racing snowplow” style and one or two held on to the instructors. But most tackled the course with assurance and a few with insouciance.

Day 7: “What’s the problem?”

The triumph, however, was collective: these are not sickly lives prolonged by an experimental medical procedure but children who, if anything, perform better than other kids because they exercise and eat more healthily and, having learned at close quarters how precious life is, are determined to make the most of it.

The competition was started by a liver recipient, Liz Schick, a British-born mother of two living in Switzerland who, like so many recipients, wanted to say ‘thank you’ to the world and has done it in an unforgettable way. As one 15-year old girl, who had a transplant when she was 2, and has been shunted between homes to wherever the appropriate medical treatment could be obtained, said afterward to her mother, “This was the best thing I ever did.”

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Reg Green was the chief business writer for the London Daily Telegraph and a freelance commentator for the BBC. Although he specialized in economics, he wrote in his spare time for almost every section of the newspaper, including being the newspaper's jazz critic, writing travel articles, obituaries, book reviews and soccer. After emigrating to the United States he founded and edited Mutual Fund News Service, an investment newsletter. He is the father of Nicholas Green, a seven-year old California boy who was shot in an attempted car jacking while on a family vacation in Italy in 1994. The killing became a worldwide news event when Reg and his wife, Maggie, donated their son's organs to seven very sick Italians, four of them teenagers. They went on to found the Nicholas Green Foundation (https://www.nicholasgreen.org) to promote organ donation to save some of the tens of thousands of deaths around the world caused every year by the failure of one organ that could have been replaced by a donated one.